Urinary incontinence or, more specifically, urinary stress incontinence afflicts a large number of people. Although not life threatening, urinary incontinence has a dramatic negative impact on the quality of life. Vesicoureteral reflux is a congenital condition that afflicts one in one hundred children. In the more severe forms, reduced, or complete loss of kidney function can occur, and it can be life threatening.
Urinary incontinence results from dysfunctional urinary sphincter(s). The dysfunction of the sphincter(s) can be caused by disease, complications from urological procedures, or result from trauma to the pelvic region. The dysfunction of the sphincter(s) can also be caused by neurological or sphincter muscle dysfunction. In all cases, the sphincter is unable to retain urine in the bladder as normal.
Currently, there are several techniques and devices that are used to treat urinary incontinence. There are surgical solutions in which artificial sphincters are implanted into tissue surrounding the urethra. These artificial sphincters function as a valve and can be actuated by the patient. Other surgical implants are rubber-band like devices that are placed around the outside of the sphincter muscle and urethra and assist the sphincter in retaining urine. Some less invasive techniques involve the injection of bulking agents the submucosa of the urethra. The bulking agents can be biologically compatible materials such as Teflon, biomaterials such as bovine collagen, or autologous materials such as fat, collagen, muscle, or cartilage. Other therapies that are used include electrical stimulation of the sphincter muscle and biofeedback techniques.
Vesicoureteral reflux is similar to stress incontinence in that the vesicoureteric junction functions like a sphincter. The vesicoureteric junction is at the junction of the ureter and the bladder. In a normal vesicoureteric junction, the ureter joins the bladder through the muscularis mucosea of the bladder in an oblique fashion. During micturition, the muscularis mucosea contracts closing the ureter. Thus, the vesicoureteric junction acts as a check valve and prevents urine from flowing back into the kidney during bladder contraction during micturition. In an abnormal vesicoureteric junction, the ureter joins the bladder through the muscularis mucosea of the bladder in a perpendicular fashion. During micturition, the ureter remains open allowing the urine to flow back in the ureter. The backwards flow of urine and the associated pressurization of the ureter and kidney result in dilation of the ureter and scarring of the kidney. Interventional treatment of this condition consists of surgery and injection of bulking agents. Mild cases of reflux can be managed with medication.